Basic Information
| Provider Information | |||||||||
| NPI: | 1699903153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PULIDO | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | GLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 16TH AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98122 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 16TH AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063202233 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ML60097301 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.